tbuckley/cabot-search huggingface dataset:
Abstract 13415: Coronary Calcium Score on Standard of Care Oncologic CT Scans for the Prediction of Adverse Cardiovascular Events in Patients With Non-Small Cell Lung Cancer Treated With Concurrent Chemoradiotherapy
Authors: Efstratios Koutroumpakis, TING XU, Juan Lopez-Mattei, Susan Gilchrist, Kelsey Corrigan, Tinsu Pan, Yang Lu, Radhe Mohan, Xiaodong Zhang, Qing Meng, Ruitao Lin, Tianlin Xu, Anita M Deswal, Zhongxing Liao
Journal: Circulation (2022)

Introduction: Chemoradiotherapy (CRT) has been associated with increased incidence of cardiovascular (CV) adverse events (CAE) including coronary events. Coronary calcium scoring (CAC) has shown to predict coronary events beyond the traditional CV risk factors. This study examines whether CAC, measured on standard, non-gated, non-contrast chest CT (NCCT) imaging, predicts the development of CAE in patients with non-small cell lung cancer (NSCLC) treated with CRT. Methods: Patients with NSCLC who were treated with CRT at MD Anderson Cancer Center from 7/2009 until 4/2014 and who had at least one NCCT scan within 6 months from their first CRT were identified. CAC scoring was performed on NCCT scans by an expert cardiologist and a cardiac radiologist following the 2016 SCCT/STR guidelines (software: Syngo.Via, Siemens Healthcare). CAE were graded based on the most recent Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. CAE were also grouped into i. coronary/vascular events ii. arrhythmias iii. heart failure or iv. pericardial disease. All CAE were adjudicated by a board-certified cardiologist. Results: Out of a total of 193 patients, 45% were female and 91% were white. Median age was 65 years (IQR: 58-72) and median BMI was 27 kg/m 2 (24-32). Of 193 patients, 142 (74%) had CAC &gt; 0 Agatston units (AU), 93 (48%) had CAC &gt; 100 AU and 36 (49%) CAC &gt; 300 AU. Twenty-nine patients (15%) developed a grade &gt; 2 CAE during a median follow up of 26.2 months (12.7-53.5). Of those, 11 (38%) were coronary/vascular events. In the multivariate cox regression analysis, controlling for mean heart dose and pre-existing heart disease, higher CAC was independently associated with development of a grade &gt; 2 CAE (HR: 1.04, 95% CI: 1.01-1.08, p=0.022) and with worse OS (CAC &gt; 100 AU, HR: 1.64, 95% CI: 1.11-2.44, p=0.013). In a sub-analysis evaluating the type of the CAE, it was the coronary/vascular events that were significantly associated with higher baseline CAC (median: 676 AU vs 73 AU, p=0.035). Conclusions: CAEs are frequent in patients with NSCLC treated with CRT. CAC calculated on “standard of care” NCCT can predict the development of CAEs and specifically coronary/vascular events, as well as OS, independently from other traditional risk factors and radiation mean heart dose.
Abstract 12900: To Rescue or Not to Rescue? Multiple MitraClips for Ruptured Chordae on VA-ECMO
Authors: Jacob Baer, Tarun Dalia, Zubair Shah, Peter Tadros, Mark A Wiley, Trip Zorn, Loren D Berenbom, Bhanu Gupta
Journal: Circulation (2022)

Background: Role of MitraClip as rescue therapy in patients with severe mitral regurgitation (MR) in the setting of ruptured chordae with profound cardiogenic shock in hypertrophic obstructive cardiomyopathy (HOCM) is not well known. Case: 60-year-old male presented with profound cardiogenic shock requiring ECMO with severe lactic acidosis. Past medical history included HOCM s/p septal ablation and ICD, mild MR, a-fib s/p watchman, and CKD stage 3.Transesophageal echocardiogram demonstrated a flail posterior mitral valve leaflet due to ruptured chordae tendineae with anteriorly directed jet of severe MR (figure 1A). VA-ECMO was initiated for profound hypotension. 3 MitraClips were required as rescue strategy as the patient was deemed too critical to undergo surgical repair. Post procedure, MR was mild with a mean MV gradient of 4 mmHg at the end of the procedure (figure 1B). 15 months post-hospitalization, patient reported dyspnea on exertion. Exercise stress echo revealed a mean MV resting gradient of 7 mmHg that increased to 16 mmHg at 50 W exercise (figure 1C). Invasive hemodynamics showed a mean gradient of 12 mmHg between LV end-diastolic pressure and pulmonary capillary wedge pressure (figure 1D) confirming severe mitral stenosis. The patient is currently being evaluated for surgical MV replacement. Discussion: Transcatheter edge-to-edge mitral valve repair (TMVr) has been studied extensively in patients with dilated cardiomyopathy, and chronic stable severe MR. There is limited data to show that TMVr can be used as salvage therapy in patients with acute torrential MR with underlying HOCM while being supported with ECMO. However, long-term sequelae needs meticulous follow up and prospective studies to establish short and long-term outcomes and safety. This case highlights potential role of TMVr in acute MR settings in the extreme case of profound cardiogenic shock requiring VA-ECMO leading to candidacy for mitral valve replacement in ambulatory setting.
Abstract 13040: Insulin-Like Growth Factor-1 Upregulates Larp6 via Translational and Post-Translational Mechanisms in Vascular Smooth Muscle Cells, Leading to Elevated Collagen Production
Authors: Svitlana W Danchuk, Patrice Delafontaine, Yusuke Higashi
Journal: Circulation (2022)

Introduction: Collagen content in atherosclerotic plaque is a hallmark of plaque stability. We have shown that insulin-like growth factor-1 (IGF1) increased collagen content in atherosclerotic plaques of Apoe -/- mice. We have identified LARP6 (La Ribonucleoprotein Domain Family, Member 6), a type I collagen mRNA-binding protein, as a mediator of IGF1-dependent type I collagen upregulation and increased mature fibril formation by smooth muscle cells (SMC), however specific mechanism has not been elucidated yet. Methods and Results: Micro-RNAs, including miR-1976 have been shown to bind to LARP6 mRNA. We found that SMC treatment with IGF1 significantly downregulated miR-1976 by 41±5% after 3h (P&amp;lt;0.05), consistent with the IGF1-induced LARP6 upregulation. In fact, miR-1976 mimic (20 nM) decreased LARP6 by 67% (P&amp;lt;0.05) and reduced type I procollagen protein levels by 85% (P&amp;lt;0.05). MiR-1976 mimic inhibits IGF1-induced LARP6 upregulation showing miR-1976 involvement in IGF1 effect on LARP6. It has been reported that LARP6-mediated promotion of procollagen synthesis may be regulated by phosphorylation of LARP6, therefore we investigated whether IGF1 induces LARP6 phosphorylation in cultured human aortic SMCs. For this experiment, SMCs were serum-starved and treated for 0-48h with 10 ng/mL IGF1. LARP6 protein was detected by immunoblots as a single 67kDa band in untreated SMC. However, after 6h of IGF1 treatment there was additional phosphorylated LARP6 band detected at 70 kDa. The levels of 70kDa LARP6 time-dependently increased up to 18h of treatment, with a concomitant increase of type I procollagen and collagen expression levels. Conclusions: In summary, our data suggests that (i) IGF1 downregulates miR-1976, thereby increasing LARP6 expression levels and (ii) IGF1 induces phosphorylation of LARP6, thereby promoting LARP6 activity. Our study revealed novel mechanisms underlying IGF1-induced type I collagen upregulation in vascular SMC and potentially in atherosclerotic plaques.
Abstract 13408: Vaping Realities: Views From Youth
Authors: kandi L walker, Alison C McLeish, Osayande Agbonlahor, Madeline M Tomlinson, Lindsey A Wood, Kolbie Vincent, Savanna Kerstiens, Julianna Clarke, Eowyn Garfinkle Plymesser, joy L hart
Journal: Circulation (2022)

Introduction: Youth e-cigarette use is a pressing public health issue. To better understand the landscape of youth e-cigarette use, we engaged middle and high schoolers (N=37) in a photovoice project and focus group interviews. Methods: Members of the VAPERACE Center’s Youth Advisory Council documented experiences with vaping through photographs from October 2021-April 2022. A question was posted each month (e.g. Where do you see vaping?), and participants recorded responses through photographs and then discussed these with the group, focusing on how the photographs conveyed the reality of vaping in their lives. They also participated in focus groups with open-ended questions designed to spur conversation about direct experiences with vaping and their related perceptions, attitudes, and beliefs. Using the constant comparative method, participant responses were analyzed for key themes. Results: Overwhelmingly, the photographs and focus group responses indicate that these youth have considerable exposure to vaping. Their photos documented that vaping pervades many aspects of their lives (e.g. in cars and school bathrooms, at parties and sporting events). Comments such as, “It’s everywhere. Everywhere you go. Everywhere you look.” underscore the degree to which youth confront vaping. Additionally, participants said that promotion of vape products was common, from the stores they entered to their social media feeds, and agreed on the power of social media influencers, which were paid more attention than PSAs. Because one “can’t hide from vapes,” one needs strategies to resist use, and these youth emphasized that “exit strategies” and face-saving approaches (e.g. “Thanks, but I’ve got a tennis match.”) worked better than strong, direct messages (e.g. ”No!”). They also expressed concerns about health effects, including CVD, and negative environmental impacts from trash produced by disposable e-cigarettes. Conclusions: The photovoice and focus groups revealed considerable exposure to vaping. Because these youth perceive that exposure cannot be avoided, they emphasized strategies to decline use. Thus, health advocates should consider strengthening educational programming to assist youth in honing refusal skills, especially indirect ones.
Abstract 13052: Clinical Utilization of Natriuretic Peptide Levels Independent of WATCH-DM Score for Heart Failure Prediction in a Large-Scale Asian Diabetic Population - A Multi-Center Cohort Study
Authors: Chung-Lieh M Hung, Jiun-Lu Lin, Chih-Yuan Wang, Yen-Wen Wu
Journal: Circulation (2022)

Introduction: Type 2 diabetes is an important co-morbid condition strongly associated with the risk of developing heart failure (HF). Risk scores such as the WATCH-DM score that predict the occurrence of HF among diabetes patients are largely based on data collected from white ethnicities. Hypothesis Here, we sought to investigate surrogate markers for predicting HF among type 2 diabetes patients of Asian ethnicities Methods Data on baseline characteristics (according to WATCH-DM scoring), laboratory information (mainly sugar profiles, renal function, and Natriuretic Peptide [NP]: N-Terminal Pro-B-Type Natriuretic Peptide [NT-proBNP], and 12-lead surface electrocardiography (ECG) findings were collected among adult Asians (aged ≥ 20 years old) with type 2 diabetes free from HF diagnosis from a multi-center cohort. We analyzed the clinical indicators for incident HF during the entire course of follow-up. Results: Among 6,668 study participants (mean age: 62.9±14.3 years, 49.3% male), the overall HF incidence was 13.7% (n=916) during a median of 3.6 years ([25 th ~75 th ]: 1.86~5.57 years) of follow-up period. Using backward multivariate selection, we identified aging (adjusted odd ratio [aOR]: 1.21, per 10-year increment), higher body mass index (aOR: 1.11, per 5 kg/m 2 increment), history of myocardial infarction (aOR: 2.26), atrial fibrillation rhythm (aOR: 1.72), prolonged QRS duration (aOR: 1.08, per 10-ms increment) by ECG (according to WATCH-DM score), higher NT-proBNP level (aOR: 1.47, per 1 log-transformed unit increment), and renal impairment (aOR: 1.06, eGFR per 10 mL/min/1.73m 2 decline) as independent predictors of incident HF. The optimal cutoff of NT-proBNP in predicting HF incidence was 77.3 pg/mL. Conclusions: In this large-scale survey, our findings highlighted the baseline clinical indicators and the potential utilization of ECG and NP in HF prediction among diabetic Asians. Additionally, we demonstrated that optimal predictive value of NP to be remarkably lower than contemporary HF cutoff independent of WATCH-DM score.
Abstract 12927: A Deep Learning Algorithmic Approach to Identify Predictors of In-Hospital Outcomes in Takotsubo Cardiomyopathy
Authors: Akil A Sherif, Ajay K Mishra, Siddharth Agarwal, Anoop Titus, Aiswarya Rajendran, Eddison Ramsaran
Journal: Circulation (2022)

Introduction: The use of deep learning (DL) through artificial neural networks is increasingly being employed to analyze large, complex datasets in clinical research allowing for new insights. Takotsubo cardiomyopathy (TTS) has an incidence of 12.4% with a reported in-hospital mortality of 5% in the US. While overall risk factors for the condition have been identified, data regarding in-hospital predictors are scant. We sought to apply a DL Artificial Neural Network (ANN) algorithm to identify predictors of in-hospital mortality in patients with TTS. Methods: The National In-patient Sample is the largest, publicly available, repository of in-patient data comprising a 20% stratified sample of all US hospital discharges. We identified all unweighted hospitalizations with a primary diagnosis of TTS from 2016-2019 using International Classification of Diseases, Tenth Revision diagnosis codes. Data regarding demographics, hospital characteristics, known confounders and associated secondary diagnoses were abstracted. These data were then analyzed using a multilayer perceptron ANN where 70% (4,579) of the dataset was used for training and 30% (1,894) for testing. An independent variable importance analysis was also performed. Results: The training and testing models were able to accurately predict outcomes in 98.6% and 98.2% of the data, respectively. ANN identified covariates with high independent variable importance (normalized importance of &gt;70%) include interstitial lung disease, ventricular fibrillation, end-stage renal disease, 3rd degree AV block, sudden cardiac arrest, and acute PE (Model AUC: 0.952). Conclusions: Deep learning-based algorithms utilizing ANNs have the potential to identify predictors of in-hospital mortality with significant accuracy in large volume databases such as the NIS. Among all the covariates that were analyzed, our model was able to identify covariates associated with high importance in predicting outcomes.
Abstract 13157: Workplace Culture and Biomarkers of Sympathetic Activation
Authors: joy hart, kandi walker, Brad Shuck, Shesh N Rai, Jayesh Rai, Shweta Srivastava, Sanjay Srivastava, Shesh N Rai, Aruni Bhatnagar, Rachel J Keith
Journal: Circulation (2022)

Workplace environment can impact health, but most research has focused on toxic chemicals. Recently, workplace culture—experiences, values, and behaviors unique to a workplace—is studied for its impact on overall health risk; however, connections with robust biologic markers of health remain to be established. Therefore, we examine associations between work environment and urinary levels of catecholamines and their metabolites as biomarkers of sympathetic activation. In 2018-19, we recruited participants (n=219) from an ongoing CV risk cohort to investigate workplace culture, overall well-being, and stress. Participants completed 7 questionnaires. Clean catch urine samples were used to measure catecholamines and their metabolites. To estimate associations between work and health scales and log or logit-transformed outcomes we used Pearson correlation and linear regression models adjusting for demographics and creatinine. Participants reporting higher well-being had lower levels of dopamine (DA) ( r = -0.28), serotonin (5HT) ( r = -0.17), and 3-methoxytyramine (3MT) ( r = -0.31), a product of dopamine breakdown. Participants reporting a more engaged workplace had lower levels of DA ( r = -0.20) and 3MT ( r = -0.22). Those reporting more positive workplace culture had lower levels of DA ( r = -0.17) and 3MT ( r = -0.26) and higher levels of norepinephrine ( r = 0.19) and 5-hydroxyindole-3-acetic acid (HIAA) ( r = 0.22). When participants identified more workplace isolation, they had higher levels of DA ( r = 0.19) and 3MT ( r = 0.19). Positive workplace culture was correlated with lower levels of DA ( r = -0.22) and 3MT ( r = -0.28) and higher levels of HIAA ( r = 0.22) and homovanillic acid ( r = 0.20). Given high correlations between catecholamines, we used 3MT for linear regression. In fully adjusted models we found in more positive work cultures, levels of 3MT remained significantly lower (β = -0.065 ±0.025, p = 0.01), accounting for 23% of the variance, and a significant positive association between workplace isolation and 3MT (β= 0.064 ±0.030, p = 0.04), accounting for 22% of the variance with 3MT, which may reflect greater dopamine degradation. These findings suggest an important relationship between how we work and sympathetic nervous system activity.
Abstract 14139: Differential Benefit of Non-Invasive Cardiac Stress Testing by HEART Score Risk Stratification
Authors: Aniket A Kawatkar, Adam Sharp, Aileen Baecker, Rita F Redberg, Mingsum Lee, Maros Ferencik, Steve Goodacre, Praveen Thokala, Yi-Lin Wu, Ernest Shen, chengyi zheng, Visanee Musigdilok, Benjamin Sun
Journal: Circulation (2022)

Introduction: AHA guidelines recommend non-invasive cardiac testing (NIT) within 72 hours after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS), after acute myocardial infarction (AMI) has been excluded. However, the effectiveness of this strategy to reduce the risk of future AMI or death, in low-risk patients is contested. Hypothesis: We hypothesized that in patients with low risk based on history, electrocardiogram, age, risk factors and troponin (HEART) based scoring, early NIT may not be beneficial compared to higher risk. Methods: We compared the effectiveness of early NIT vs. no early testing, in a retrospective cohort of adult (age ≥18) members of the Kaiser Permanente Southern California health system from 05/2016-12/2020. We included all adults presenting at EDs with suspected ACS and who had data to compute HEART score. We stratified the cohort into low risk (score 0-3); intermediate risk (score 4-6) and high-risk (score ≥7) based on HEART score. Within each group, confounder adjusted instrumental variables models were used to evaluate the marginal effect of early NIT, and the number needed to treat (NNT) was calculated as the inverse of the absolute composite risk reduction in death/AMI within 30 days of ED discharge. Results: The cohort included 174,936 patients [61% Low risk (mean age 53; female 58%; early NIT 5%), 36% intermediate risk (mean age 71; female 72%; early NIT 18%), and 3% high risk (mean age 74, female 45%; early NIT 23%)]. The risk reduction in 30-day death/AMI due to early NIT increased progressively through the intermediate-risk (NNT = 59) and high-risk groups (NNT = 24) (Table 1). Risk reduction in the low-risk group was not statistically significant. Conclusions: HEART score based high risk patients may benefit the most from early NIT. However, the majority of the suspected ACS cohort was classified as low risk and the benefit of early NIT on 30-day death/AMI was uncertain in this low-risk group.
Abstract 13363: Incidence, Management, and Outcomes of Pediatric Pulmonary Embolism in the United States: <i>An Observational Study Using Data From the Pediatric Health Information Systems Database</i>
Authors: Radhika Rastogi, Oluwatimilehin Okunowo, Jennifer Faerber, Constantine D Mavroudis, Therese M Giglia, Char Witmer, Leslie Raffini, Michael O'Byrne
Journal: Circulation (2022)

Introduction: Pulmonary embolism (PE) is a rare but potentially severe disease. Strategies for treatment in adults are evolving to increasingly include local thrombolysis and thrombectomy, in addition to mainstay treatment of anticoagulation (AC). Neither the incidence of pediatric PE nor contemporary evidence on treatment have been well studied, so this study addresses these knowledge gaps by describing PE patients and their treatment outcomes. Methods: A retrospective multicenter cohort study was performed using patients ≤18 years with PE at US hospitals contributing data to the Pediatric Health Information Systems Database from 1/1/2015-9/1/2021. This study 1) described the clinical characteristics of PE patients, 2) examined trends in treatment strategies, and 3) used multivariable models to examine the relationship between treatment and outcomes (in-hospital mortality, length of stay (LOS), and adjusted costs of hospitalization). Results: In total, 3148 unique patients with PE were studied (54% female, median age 15 years). Most patients (63%) had at least one comorbid condition, the most common being congenital heart disease (25%). Most patients received anticoagulation only (88%), 7% underwent systemic thrombolysis, and 5% underwent local thrombolysis and/or thrombectomy. In-hospital mortality was 7.5%, with 62% of patients requiring ICU admission, and 7.4% receiving extracorporeal membrane oxygenation. Median (IQR) LOS was 10 days (21) and median cost was $54,026 (145,231). Use of thrombectomy and thrombolysis did not increase over time (p=0.98). In multivariable analysis, receipt of local thrombolysis and/or thrombectomy was associated with lower mortality (adjusted OR: 0.54, p=0.03). Systemic thrombolysis (β=1.73, p&lt;0.001) and local thrombolysis and/or thrombectomy (β=1.35, p=0.003) were associated with higher costs than AC alone, without significant associations between treatment and LOS. Conclusion: Pediatric PE is associated with high mortality and healthcare utilization, reflecting the medical complexity of the patients. Rates of local thrombolysis and thrombectomy remain low, and further study is required to elucidate which patients may benefit from such procedural management.